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Home My WebLink AboutHAZ-BUSINESS PLAN 8/6/1998 .. I. I'S j 1 I i I -~ I~ I I I '- \) ~ ~ ---- 1:1. lVl 11 1" - ". U.LAN .J.. 1 V .l..8J:"' - SITE DIAGRAM [ ;X'/) II FACILITY DIAGRAM . (¡kilt {j LÚ¡;l. <f¡Ø 1 tUj/~ ItlJ1¿ Business Name: Business Address: For Office Use Only FirST In Stetion: Area Meo ;:; \nsoection Station: of NORTH 0 tí r 1 ((,f(f~ {\ .r\~)( . , J,.oÇ-¥ ç çr/:> ~'h\)-l~. Wfrl j)JfP-t-_5 ,,--~- --- - / ~\tP"~ v . ?wr" H L- H L- t}O((yl!; D F7ð-MfI1 tv/;/e - 0q¡¿¡J - '1--- I ¡ ---J- (P ßCÞI1 ¿;höp J)r.e.a 5Jv{ .e~ r(1 Gt.. . I o ~1(~ ~,e,( A(¡trO s (Lt'I I H H -------- - ------ ------------ ---- -------------. r------' ------- -. - ~-~----- --~--------- ----- -- ---1 (ÿ( \0 J~ I . r (1;(. f \ X µ~Jr~VI ., L --- -. ---- -- ---- ------- -------------- -- -------_. ----- ?J/;;!c ¡all t ,",-~ -~--- ------ ----- - -- --. -.------ FINANCE DEPARTMENT CITY OF BAKERSFIELD P.O. BOX 2057 BAKERSFIELD, CALIFORNIA 93303 .. RETURN SERVICE REQUESTED /- \." . Lf - 00 "...z ,. ~ , _ ' '".: c~ ':, " , ! ,~ ¡ . / ~,...' , ,·.r 'oj.. ~ r~~'-:L: ~~~=,TE_C; ~~f!~~ rV Q? '7,r ~ ; . . . r I (~....... i'., : \: (". -I' . -~ ;." ~, ,LJ ,~J ( : ~-= ~~ c.;,; " - , , ,:' . . ~:,: .¿:- ':~ "~ .', í)-' 'I'~:':C'"",!( ~ ¡l' I¡J~ '.1.... .''':[/ " /;-.....! " . ,t ;' ".r)! ~ _. i-,À 4 - ,r \'þD--- co '1 )~ hJ-oJ'- - -:7\0 It> ALLTðOO 93309a005 ~~OO 06 06/09/00 RETURN TO ~ENDER :ALL TUNE AND LUBE RODRIGUEZ MOVED LEFT NO ADDRESS UNABLE TO FORWARD RETURN TO SENDER Aun8 93389 ~_··.:r;"-'·:;'t.·':T .:-'".'!/:;'- -: -. ---........ 11..1....11,..11 ,II 11",11",1,11 - ïTi*,1n)~"f' I'I-H'i:,:,, IHnffl-p.~mlJ 1!.IIltlll to Operüte PerDl.it Hazardous Materials/Hazardous Waste Unified Permit CONDITIONS OF PERMIT ON REVERSE SIDE This permit is issued for the following: !!H~~ardous Materials Plan '''~rground Storage of Hazardous Materials "'Q,agement Program mm'" Waste 4800 PERMIT ID# 015-021.001581 ALL TUNE & LUBE LOCATION Issued by: WHITE Bakersfield Fire Department OFFICE OF ENVIRONMENTAL SER VICES 1715 Chester Ave., 3rd Floor Bakersfield, CA 93301 Voice (805) 326-3979 FAX (805) 326-0576 ~~- ph Huey, ffiee of ental Servi es June 30, 2000 Approved by: Expiration Date: e STATEMENT OF ACCOUNT e CITY OF BAKERSFIELD 1501 TRUXTUN AVE BAKERSFIELD, CA 93301-5201 <;805)326-3979 DATE: 9/01/98 TO: ALL TUNE AND LUBE 4800 WHITE LN STE A BAKERSFIELD,CA 93309 CUSTOMER NO: ""0- ;394~ CUSTOMER TYPE: ES/ 3944 , ". ." ." ---------------------------------------------------------------------------- CHARGE DATE DESCRIPTION REF-NUMBER DUE DATE TOTAL AMOUNT ------ -------- --~~------~~~----~-~~---- ---------- -------- -------------- ^, 8/01/98 BEGINNING BALANCE" 6/29/98 PAYMENT REFND 8/19/98 MR'TNT REFUND VCHRS .00 18. 50-- 18. 50 FOR QUESTIONS OR CHANGES TO YOUR ACCOUNT PLEASE CALL THE NUMBER AT THE TOP OF THIS STATEMENT. -------------- -------------- -------------- -------------- CURRENT OVER 30 OVER 60 OVER 90 -------------- -------------- -------------- -------------- DUE DATE: 10/01/98 PAYMENT DUE: TOTAL DUE: 18. 50-- $18. 50-- CUSTOMER^TYPE: ES/ TOT AL DUE: 3944 $18. 50- 6'._ ~ e e CITY OF BAKERSFIELD CLAIM VOUCHER I Vendor No. I certify that this claim is correct and valid. and is a proper charge against the City Agency and account indicated, CLAIMANT'S NAME AND ADDRESS: All Tune and Lube 4800 White Ln Bakersfield, CA 93309 (AUTHORIZED SIGNATURE OF CITY AGENCY) Date: 08-12-98 Initials of Preparer : CITY DEPARTMENT: FINANCE PLEASE PROVIDE SHORT EXPLANATION OF PAYME (Including Contract Number if Applicable) This business overpaid their Hazardous Materials bill by $18.50. For that reason they now have a credit of $18.50 which we will be refunding. Fund Dept. Base Ell Objt Project # Invoice # Amount Date of Invoice 011 0000 123 7900 $18,50 VOUCHER TOTAL $18.50 SECTION 72, PENAL CODE FINANCE DEPT. USE ONLY Section 72, Presenting False Claims. Every person who with intent to defraud, presents for allowance or for payment to any state board or officer, or any county, town, city district, ward or village board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill. account, voucher, Examined & Approved for Payment Amount or writing, is guilty of a felony, f ~ ~ ..." / ,j' . ~ BAKERSFIELD FIRE DEPARTMENT . e - MEMORANDUM DATE: August 6, 1998 TO: Susan Chichester FROM: Esther Duran SUBJECT: Claim Voucher Please issue a Claim Voucher to refund overpayment of$18.50 made by All Tune and Lube. They made a payment of$128.50 on 6/26/98 and then another payment of $18.50 on 6/29/98. They now have a credit of $18.50. Please send refund to: All Tune and Lube 4800 White Ln Bakersfield, CA 93309 Thank you, led 'Y~ ~ ~~ §f;p V#;OP8 ~ ..A ~emw? " Ó'ê, "'" .--- . " e STATEMENT OF ACCOUNT e CITY OF BAKERSFIELD 1501 ïRUXTUN Ai,iE BAKERSFIELD, CA 93301-5201 (805) 326-3979 DATE: 8/01/98 TO: ALL TUNE AND LUBE 4800 WHITE LN STE A BAKERSFIELD, CA 93309 CUSTOMER NO: 3944 CUSTOMER TYPE: ES/ 3944 ---------------------------------------------------------------------------- CHARGE DATE DESCRIPTION REF-NUMBER DUE DATE TOTAL AMOUNT ------ -------- ------------------------- ---------- -------- -------------- 6/30/98 BEGINNING BALANCE 6/29/98 PAYMENT ,00 18. 50-- FOR QUESTIONS OR CHANGES TO YOUR ACCOUNT PLEASE CALL THE NUMBER AT THE TOP OF THIS STATEMENT. -------------- -------------- -------------- -------------- CURRENT OVER 30 OVER 60 OVER 90 --------------- -------------- -------------- -------------- DUE DATE: 8/31/98 PAYMENT DUE: TOTAL DUE: 18, 50-- $18.50-- DATE: 8/01/98 DUE DATE: 8/31/98 PLEASE DETACH AND SEND THIS COPY WITH REMITTANCE REMIT AND MAKE CHECK PAYABLE TO: CITY OF BAKERSFIELD PO BOX 2057 BAKERSFIELD CA 93303-2057 CUSTOMER NO: 3944 CUSTOMER TYPE: ES/ TOT AL DUE: 3944 $18. 50- .... ,) ~~ _.,,J, . MR430I07 Customer TO Last statement Last invoice Current balance Pending Type options, press 5::Display Opt Trans Date Code 8/01/98 6/30/98 6/29/98 6/26/98 6/11/98 6/10/98 6/01/98 6/01/98 5/01/98 F3=Exit stmrn stmrn stmrn HMO 05 stmrn CITY OF BAKERSFIELD ~ M4IÞellaneous Receivables In~ry 3944 8/01/98 0/00/00 18,50- ,00 Name: Addr: ALL TUNE AND LUBE 4800 WHITE LN STE A BAKERSFIELD, CA 93309 Enter. Combined Detail A ACTIVE ENVIRONMENTAL SERVICES Description Statements Processed Statements Processed PAYMENT PAYMENT Statements Processed HAZ MAT HANDLING FEE Statements Processed SSOOl CA STATE SURCHARGE stmrn Statements Processed F12::Cancel * = Pending Amount .00 .00 18.50- 128.50- .00 110.00 .00 18.50 .00 Chg Balance Typ 18,50- 18.50- 18.50- .00 128,50 128.50 18.50 18.50 A .00 8/05/98 15:58:31 Bnk G Cd L 00 Y 00 Y + BAKERSFjiLD CITY FIRE DEPAWMENT HAZAm50US MATERIALS INVENTORY Business Name Â:lL- -rutJ¡S Address 4~ðO ~ ~,~ L.J Page_of_ ž±-A CHEMICAL DESCRIPTION 1) INVENTORY STAì\.JS: þ" .~ Addition itt Revision I } Deletion I } 2) Common Name: f2.EL~CUS.0 AJ0''í1 Ç;fléE;,z-6 Check if chemical is a NON TRADE SECRET I) TRADE SECRET I ) 3) DOT # (optional) Chemical Name: AHM [ ) CAS # 4) PHYSICAL & HEALTH HAZARD CATEGORIES PHYSICAL Fire [) Reactive [) Sudden Release of Pressure [ } HEALTH Immediate Health (Acute) þ!J Delayed Health (Chronic) [ } , 5) WASTE CLASSIFICAì10N (3-digit code from DHS Form 8022) USE CODE ~ 6) PHYSICAL STATE Solid [} Liquid (40) Gas [ } Pure [} Mixture [] Waste Ii CHEC1CNJ.. THAT APPtY Radioactive [ ] 7) AMOUNT AND TIME AT FACIUTY Maximum Daily Amount: Average Daily Amount: Annual Amount: Largest Size 'Container: # Days On Site 10f ¿¿D ~~ '30$ UNITS OF MEASURE Ibs [ ) gal ~ ft3 [ ) curies [ ) 8) STORAGE CODES a) Container: b) Pressure: cj Temperature: PLAsTic.. \Yl.tJov\ f 4 Circle Which Months: . All Year, J, F, M, A, M, J, J, A. S, 0, N, D 9) MIXTURE: List the three most hazardous chemical components or any AHM components COMPONENT CAS # %WT AHM [ ] [ ] [ ) 1) 2) 3) 10) Location i µ S , í> t:.. N t.-V Cor<NC...><... o-F <bl D G- CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New [ ) Addition JtIIr Revision [ ) Deletion [ ] Check if chemical is a NON TRADE SECRET [ TRADE SECRET [ ) 2) Common Name: ~A"ÍIc.. ~1'-<I,>S'~ <-r¿"u, {> 3) DOT # (optional) Chemical Name: AHM [ ] CAS # 4) PHYSICAL & HEALTH HAZARD CATEGORIES PHYSICAL Fire &at Reactive [) Sudden Release of Pressure [ } HEALTH Immediate Health (Acute) [] Delayed Health (Chronic) [ ) 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) use CODE Zk> Lt.Jß~ 6) PHYSICAL STATE Solid I] Liquid 1_ Gas I } Pure 1ft Mixture [) Waste. I J CHECK AU.. THAT APPlY Radioactive [ ] 7) AMOUNT AND TIME AT FACiliTY Maximum Daily Amount: Average Daily Amount: Annual Amount: Largest Size Container: # Days On Site '/0 -5'£ Z '7-3- 3(:.') UNITS OF MEASURE Ibs [ ] gal (.i!J ft3 [ ) curies [ ] 8) STORAGE CODeS a) Container: b) Pressure: c) Temperature: Z. t d. Circle Which Months: All Year, J, F, M. A, M, J, J, A. S, 0, N, D 9) MIXTURE: List the ,three most hazardous chemical components or any AHM components COMPONENT CAS # %WT AHM [ ) I J [ ] 1 ) 2) 3) cc:.'1LJ~-ÇZ o?' INs/oe --- ~c..J'ALL ocuments. ~~ tgga REœOtV LEPCST~FCRM BAKERS-=LD CITY FIRE DEP.wTMENT HAZARDOUS MATERIALS INVENf6RY Page_of_ 3usiness Name Address CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New I ] Addition I ] Revision I ] Deletion I ] Check if chemical is a NON TRADE SECRET I ] TRADE SECRET I ] 2) Common Neme: 3) DOT # (optional) , Chemical Name: AHM I] CAS # I I 4) PHYSICAL & HEALTH PHYSICAL HEALTH I I HAZARD CATEGORIES Fire I ] Reactive I ] Sudden Release of Pressure I] Immediate Health (Acute) I ] Delayed Health (Chronic) I] 1 ¡ 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) USE CODE ! I 6) PHYSICAL STATE Solid I] Uquid I ] Gas I ] Pure I] Mixture I ] Waste I] Radioactive I ] O1EO<AI.l. THAT APPlY i 7) AMOUNT AND TIME AT FACIUTY UNITS OF MEASURE 8) STORAGE CODES Maximum Daily Amount: Ibs I ] gal I ] ft3 I ] a) Container: Average Daily Amount: curies I ] b) Pressure: Annual Amount: c) Temperature: Largest Size Container: # Days On Site Circle Which Months: All Year. J, F. M, A, M, J, J. A. S, 0, N, D 9) MIXTURE: Ust COMPONENT CAS # %WT AHM the three most hazardous 1 ) I] chemical components or any AHM components 2) I] , 3) I] : , 10) Location I CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New I I Addition [ ] Revision I ] Deletion I ] Check if chemical is a NON TRADE SECRET [ ] TRADE SECRET I ] 2) Common Name: 3) DOT # (optional) I I Chemical Name: AHM [ ] CAS # I , 4) PHYSICAL & HEALTH PHYSICAL HEALTH i HAZARD CATEGORIES Fire [ J Reactive [ ] Sudden Release of Pressure [ J Immediate Health (Acute) I ] Delayed Health (Chronic) I] i I 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) use CODE 6) PHYSICAL STATE Solid [ ] Uquid [ ] Gas I ] Pure I] Mixture I] Waste I] Radioactive I ] I CUfCKAU. THATAPPt'f 7) AMOUNT AND TIME AT FACIUTY UNITS OF MEASURE 8) STORAGE CODeS Maximum Daily Amount: Ibs [ ] gal I ] ft3 I ] a) Container: Average Daily Amount: curies I ] b) Pressure: Annual Amount: c) Temperature: Largest Size Container: # Days On Site Circle Which Months: All Year, J, F. M. A. M, J. J. A. S, 0, N. D 9) MIXTURE: Ust COMPONENT CAS # %WT AHM the three most hazardous 1) I] chemical components or any AHM components 2) I] 3) . I ) 10) Location certify unaer penalty ot law, tfat I have personally exammeci and am tamjHar Wltf the mtomation submItted on tfjs and all attacheci aocuments. I bel/eve the submitted information is true, accurate, and complete. PRINT Name & Title of Authorized Company Represenætive Signature Date $_....311'. REGIQrIIY LEPCST.IIINOtiIrAOFaW CjÖ\LlI'tY 'D(j)¡J(\ ~'(l. Lf <~CDð l.ùn (\~ LQ~ YV:L~ ð Doc- ~ -tf: Þ \ T h l',? l 0 è) g(tfC{,C[G ~?Drh(\j (ì ar~ :; c{/L l~~ ~ (t0Lt-- -<g~;) ,-q l¡;C¡ I - - =- (NSPéi:::::f"C-D ly(~/q6 ¡VO SIE,-.V5. c:::>C SPI L t -r7..Þ.>-r D.t>-'ì-- is v 'I 62.c~ í Cku.... W í2. P< ~ S'A.,l) sPt/...'-~ NzE PI2-EQuGV.., {,.J C:::.f2.cÞ.V'I o,¡:: 5 t-f:.>P .. dW CORRECTION NOTICE BAKERSFIELD FIRE"DEPARTMENT :,(0 t ~~ /", '" ~ G :.; ,.' '" . ¡ ," ~.\ :: , -7" .' I .:' .. 11,._" Locatiol1 /~ S<C'ù !.,.J.{, , ¿ ;:;,'7 11 Cd .,', Sub Div. . Elk. . Lot You are hereby required to make the following corrections at the above location: Cor. No I -:-) .' ,~¿ I L'f/L (':- -. ; (. ,. " : ,,..)' J_)(':- - c:.' ~,(' '( ,J " ~.: ( ~ ::1.... .' .. <.:" -- ~ê.V .. . i( , .. :_~ .- . , ' Completion Date for Corrections , - Date ... ., .' I " ,....) Inspector 326·3979 .,......-,--.,.----~=--""'.;- CORRECTION NOTICE BAKERSFIELD FIRE DEPARTMENT ,~ <i t"! "'\ ¡.. r i,; . . ;v Î.,/ /\L l --7'-_''-.'1:. ¡- , <: t___ '._' " i..-. LocatioI1 .~ ;(' Y.) U-.)/(' '-¿ .:riA ¿.\J ,'"" Sub Div. . Blk. . Lot You are hereby required to make the following corrections at the above location: Cor. No I ?I ~ ¡'-:.:¿ J. If\vc. F-t):.) ':.:. r: .- - '7'·7 ',.) L.' , /.r:/I,... ......t.. " .... L . , , l._ -.." ç£cc.u I( c... f;' - Completion Date for Corrections I( , ? ' I / ,'(., I I ( .I _ Date Inspector 326-3979 ~ BAKEFlFIELC'CITY FIRE DE~RTMENT HAZARDOUS MATERIALS DIVISION 1715 ,CHESTER AV£~ BAKERSFIELD, CA. 93301 HAZARDOUS MATERIALS MANAGEMENT PLAN INSTRUCTIONS: 1. io avoid fUíther action. rerum this form within 30 days of receipt. 2. ïYPE/PRINT ANSWERS IN ENGLISH. 3. Answer the questions below for the business as a whole. 4. Be brief and concise as possible. SECTION 1: BUSINESS IDENTIFICATION DATA BUSiNESS NAME: 411 Tïi/1f C;?' L á¡& LOCATION: 1JðO tu411e iY;t Stvle ¡:¡ MAILING ADDRESS: CiTY: (3ditlíSField STATE: L1l Z!P: 933ð.fPHONE:?~ R'33-9?f~ DUN & BRADSTREET NUMBEK: 71-03 CJ10 1 f PRIMARY ACìIVIT? /jlvlc /Yj()!¡Ye. r...f',.fJCllr OWNER: (/al//~/ ~c/r/0¿¿eZ-- MAiliNG ADDRESS: ¿;(5/0 6ra/;/J7/J SIC CODE: 1)31 d ;3 aft u'<Y0l'd a. I - 733d7 SECTION 2: EMERGENCY NOTIFJCATION: ~NiACT TITLE 1. dt!(/I.¿I,1;rtf,;Ç;tlb7/ &Nlllf CL" ~ / r Cø~--c.. 2. c::¡ca·. /LArt/'I&,{¿¿t: 1)f&11jlf 1f6S~ ~ ~~R.l!:rz.A.VlAfWßGG/2.. BUS, PHONE 24 HR. PHONE [1 ¡-3.3 -- ?~qJ> P3~ - ~7f 3~>"- 1027.. ¡-33 -~5?Jf JCj1---cfZðC¡ .1. , Bakersfield Fire Dept. .~dous Materials Division . ,e . HAZARDOUS ,MATERIALS MANAGEMENT PLAN ~ . - "~ . . - - .~ ;' ~'. ,. ~ SECTION 3: TRAINING: NUMBER OF EMPLOYEES: 6 MATERIAL SAFEiY DATA SHEETS ON FILE: c¡~ BRIEF SUMMARY OF TRAINING PROGRAM: O¡' I:/ufr I \'C(j7 Wiî \ ComL (' t1 t:?-\ (-CLA'f') <... SECTION 4: EXEMPTION REQUEST: I CERTIFY UNDER PENALTY OF PERJURYïHAfMY BUSINESS IS EXEMPT FROM THE REPORTfNG REQUIREMENTS OF CHAPTER 6,95 OF THE "CALIFORNIA HEALTH & SAFETY CODE" FOR THE FOLLOWING REASONS: f VIE DO NOT HANDLE HAZARDOUS MATERIALS. WE 00 HANDLE HAZARDOUS MATERIALS, BUT THE QUANirTIES AT NO TiMEEXCEED THE MINIMUM REPORTING QUANTITIES. OTHER (SPECiFY REASON) SECTION 5: CERTIFICATION: I, CERTIFY THAT THE ABOVE INFOR- MATION IS ACCURATE. I UNDERSTAND THAT THIS INFORMATION WILL BE USED TO FULFILL MY FiRM'S OBLIGATIONS UNDER THE "CALIFORNIA HEALTH AND SAFEiY CODE" ON HAZARDOUS MATERIALS (DIV, 20 CHAPTER 6.95 SEC. 25500 ET AL.) AND THÄT INACCURATE INFORMA nON CONSTITUTES PERJURY. TfTLE ~--3 -2s- DATE ? · . ... - ~ . .-...:¡. . B akersfi~ld Fire Dept. e Hazardous Materials Division e &.. HAZARDOUS. MATERIALS MANAGEMENT PLAN 't, ~ '..~ ,-- ,", . - Facility Unit Name: SECTION 6: NOTIFICATION AND EV ACUATION PROCEDURES: A, AGENCY NOTIFICATION PROCEDURES: C())Á/ 0 - (-I 8. éMPLOYE= NOTIFICAï!ON AND EVACUATION:· /;ìh/'Jld"- ÚrDi4.Ui.t -w~ro-~ :, 6u-s~r? -10 V'QCtd-L U1'lt 1Xl-tl¿'Ì1t ¡¥;'f-H? C, PUBLIC EV ACUA TIO N: 7áwt.i.-- ~ tc¡;.¡;' L\1;oJ~ D. EMERGENCY MEDICAL PLAN: hll.I CC-( +to:;¡-> ~ ~_ ':J ~I~ ~"-""--~' ..... ..~ ... ". e . BakersfieldFire Dept. e Hazardous Materials Division .....--... ... ~ . J-~. _ HAZARDO'US MATERIALS MANAGEMENT PLAN ~~ SECTION 7: MITIGATION, PREVENTION AND ABATEMENT PLAN: A. RELEASE PREVENTION STEPS: () ._ I ¿ (.... ' -rCL¥1Jt'7 Ciß J..., 10 c~k-.,L- <' /l CHv..- L~~ W n,' C h Q.J.-e... CW ~ ('A Á-- . 8. RELEASE'CONTAINMENT AND/OR MINIMIZATION: ç~~; tillcrr¡~ 'C. CLE,A.N-UP PROCE~URES: " , SECTION 8: UTILITY SHUT-OFFS (LOCATION OF SHUT-OFFS AT YOUR FACILITY): WATER: o/fL¡ o Lf~· Uit¡ ~ I NATURAL GAS/PROPANE: ELECTR!CAL: SPECIAL: LOCK BOX: YES@ IF YES, LOCATION: SECTION 9: PRIVATE FIRE PROTECTION/WATER A V AILABlllTY: A. PRIVATE FIRE PROTECTION: fJo B. WATER AVAILABILlTY (FIRE HYDRANT)':' I ( tJ /)) -iJ-;" ç Cttj ((--,)r. (/( .?:r ~ ., - ''''"''- -' ·- B~.KER~fJE. LD' ~rry FIRE' DE'~A.aTM..·:ENT'· IiAZAtlJOUS MATERIAlS INVEN-ølÁYl'" "\'r jsinessName 1/11 ~(t id.f' Address ~fè;t:J~/j 1J1t1t' ~. CHEMICAL,DESCRIPTION ,( ~:j¡~¥~~Of~ ~ (~~i~/j 9~Î ,~ftt' Jt;,¿>~ ø 1) INVENTORY STATUS: New (1 Addition ( J 2) Common Name: I ))Q~ r() I~ Revillion ( J Deletion ( J Check it chemal is . NON TRACE SECRET'r 1 ' TRADE SECRET r r 3) DOT" (oplional) Chemical Name: AHM ( 1 CAS # 4) PHYSICAL & ,HEALTIi HAZARD CATEGORIES PHYSICAL Fire () Reactive (] Sudden Release of Pressure ( ) HEAL'T1i Immediate Health (Acute) (J o.layecI Health (Chronic) 5) WASTE CLASSIFICATION (3-digit code from DHS Form 8022) 6) PHYSICAL STATE Solid ( I Gas ( 1 use CODe Pure (] Mixture [J Waste )4... CN£C1C AU. THIt' A.PA." Radioactive I ] ì) AMOUNT AND TIME AT FACIUTY Maximum Daily Amount: Average Daily Amount: Annual Amount: Largest Sìze Contamer: # Days On Site ;)00 \'50 ;:}() tf) UNITS OF M~SURE Ibs [ ] gal/~ ft3 [ 1 cunes [ ) 8) STORAGE CODES a) Container: b) Pressure: c) TemperlÙure: Circle Which Months: All Year. J. F, M. A. M. J. J. A. S. 0, N, 0 9} MIXTURE: Ust the three most hazardous chemical components or any AHM components COMPONENT CAS # %WT AHM ( ) ¡ J ¡ ) 1) 2) 3) 1 0) Location CHEMICAL DESCRIPTION 1) INVENTORY STATUS: New ( ) Addition ( ] Revision ( ] Deletion ( ] 2}Common Name: . ty1 trltn r (); I Check it chemical is a NON TRADE SECRET [] TRADE SECRET [ J 3) DOT # (optional) Chemical Name: AHM ( ) CAS" 4) PHYSICAL & HEALTH HAZARD CATEGORIES PHYSICAL Fire f J Reactive f] Sudden Release of Pressure f ] HEALTH Immediate Health (Acute) [J Delayed Health (Chronic) 5) WASTE CLASSIFICATION (3-dígit code from DHS Form 8022) USE COCE 6) PHYSICAL STATE Solid [] LiqUid)(.l Gas [ ] purKJ Mixture [ ';HEQ(""-L ~ArAPPtr Waste [] Radioactive ( J 7) AMOUNT AND TIME AT FACIUTY M8Jtlmum Daily Amount: Average Daily Amount: Annual Amount: Largest Size Contamer: # Cays On Site 3'50 rl DeD /-,tSo - UNITS OF MEASURE Ibs [ ] gal [J 1'13 ( ] curies f ] 8) STORAGe CODes a) Container: b) Pressure: c) TemperldUre: Circle Which Months: All Year. J. F. M. A. M. J. J. A. S. 0, N. C 9) MIXTURE: Ust the three most hazardous criemlca/ components or any AHM components COMPONENT CAS¡! %WT . AHM [ ) ( I [ 1 1) 2) ;II ClL Title of Authonzed Company Representative , .. ~ . - BAKæw=IELD CITY FIREDE~RTM1:N+ # -. "-. . ~. .. . ·,·;:~AZÄRDOUS MATERIAL$ ;DIVISION.,_.zo:::... ,&-.0 ( . " ) '- , .,',., ", .. 1715 CHESTER AVE.: . -,;:",·tl"..,,~I'~~""'01JqeP BAKERSFIELD, CA. 93301~ ~ ~ (805) 326-3979 f r~ ' HAZARDOUS MATERIALS INVENTORY FAC/Un' DESCRIPTION · CHECK IF BUSINESS IS A FARM [ ] : BUSINESS NAME If II 1{;l2fl r/ 4. 6...e / ;., -r-;:jA_¿? /J ÚI j J", / .JI' · FACIUTY NAME V c> I ¿V~..... Vl rt cr L-~f:2.."'l · S¡TE ADDRESS Jfe¿()cO IJ 'wI-I!'! ( · Cln- 6a!Lef~Fïe'ld STATE NATU¡:¡E CF 3USINESS I}IA.-fo MDII v¿ rc...f)t(t-r { <:.L' r¡C~ 10.//1 f Ca. :¡ :1 'I !; il ZIP C; :3 2 ðftJ : SIC ceDE 753 gr OUN & BRADSTREET NUMBER ~?- ~3 tJ? ~ ?cf ~(f) -:;¡; I;¡¿/ 2 ~ ø rIJ 6 )?j£¡ c I· ¿?¿t1 -- PHONE tþ5 601,-tJ?7'f'" , OWNE~€~AT~ .£;Jsa : MAILING ADDRESS 6616 1 C:TY l3aill/SÑelcl · - STATE ZIP c93,-~¿)7 / E~.1ERGENCY CONTACTS I'JAME c-IÍlf/lCr- ;;;;?¡'lhÚf¿ TITLE é)ú}/lt!r BUSiNESS PHONE ýðr- r33- 653F 24-HOUR PHONE ~~ tF33'--97'Jf NAME &SL1 ~otí~ ~-¿, I BUSINESS PHONE þJ 397- f?2 R~ TITLE /J1;;/J~J~r 24-HOUR PHONE çdÇ <f]3 -1'l~ f " , ~.__..." iaczJ REGION" ID'C STANCAAO'" ,","",-",,;' .~,~~